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T ' <br /> CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT <br /> P.O.Box 66(2750 Kelley Parkway) - <br /> Crystal Bay,MN 55323 15o 1L-Y oot q-/-3-0) 46113 f/ <br /> SPECIAL CONDITIONS&HOLD HARMLESS AGREEMENT <br /> General Instructions <br /> 1. You may be required to obtain other permits, i.e.well abandonmment, etc. <br /> 2. Work must not begin unless the permit card is available on the job site. <br /> 3. A 24 hour notice is required for all inspections. Call(612)249-4600. <br /> JOB SITE ADDRESS: <br /> W 4 Orar (j. <br /> Occupancy Type: )c Residential Commercial <br /> OWNER'S NAME: /h <br /> one: <br /> Mailing Address:_ --- City: — - <br /> � C r�,.�, _ 763 <br /> CONTRACTOR'S - <br /> NARIM <br /> Mit) ss•�-7Y <br /> Mailing Address: I o o 0 P;..:- Bus.pi a« City: � <br /> Demolition if planned by means of: manual disassembly <br /> X heavy equipment <br /> Permits Issued: <br /> # r-- Well Abandonment <br /> In return for issuance of said Demolition Permit,the undersigned owner hereby agrees as follows: <br /> 1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is <br /> complete. <br /> 2. Demolition debris will be kept off adjoining property and/or the public rights-of-way unless <br /> specific prior approval is obtained in writing for temporary use thereof. <br /> 3. Foundations shall be completely removed from the ground. <br /> 4. <br /> All demolition debris shall be completely disposed of off site in accordance with all <br /> applicable PCA requirements. <br /> 5. Water wells must be abandoned in accordance with State Health Department regulations. <br /> 6. Inspection required when all debris has been removed,before backfilling. <br /> w <br /> z T716zMid ai;•ort% z i •is/IE l'tOtiitnai' •6 (mu.) ON080 d0 AID-40.daxva oo 0� 1002-OZ <br />